BR 104 - R. Alvarado

     AN ACT relating to prior authorization.
     Create a new section of subtitle 17A of KRS Chapter 304 to require an insurer develop processes for electronic prior authorizations; to establish an extended length of authorization under certain circumstances; amend KRS 205.522 to require the Department for Medicaid Services or a Medicaid managed care organization to comply with Sections 1, 6, 7, 8, and 9 of this Act; amend KRS 217.211 to require governmental units of the Commonwealth to promulgate administrative regulations for electronic prescribing that include electronic prior authorization standards meeting certain requirements; amend KRS 218A.171 to require governmental units of the Commonwealth to promulgate administrative regulations for electronic prescribing that include electronic prior authorization standards meeting certain requirements; amend KRS 304.17A-005 to define "health care services," "health facility" or "facility," and "medically necessary health care services"; amend KRS 304.17A-580 to prohibit a requirement of a utilization review for the provision of emergency health care services; to establish a presumption of medical necessity; amend KRS 304.17A-600 to amend the definition of "prospective review" to include prior authorization, step therapy, preadmission review, pretreatment review, and utilization and case management; amend KRS 304.17A-603 to require certain written procedures of insurers be accessible on its Web site; amend KRS 304.17A-607 to require that decisions relating to utilization reviews are conducted by physicians of the same specialty as the ordering provider; to establish a time frame for providing utilization decisions; to allow for electronic format of certain required notices; to establish that an insurer's failure to respond within set time frames shall be deemed a prior authorization; amend 304.17A-430, to conform; EFFECTIVE January 1, 2020.